Download PIQ >> Extra Low Voltage Safety Testing

SELV - P.I.Q.
(Product Information Questionnaire for SELV Cards)
Product Safety SELV - P.I.Q.
The following list of questions are designed to provide Curtis-Straus with the information
needed to accurately evaluate your product and write your company’s Product Safety Reports.
This information must be provided in advance to insure your product can be fully evaluated and
tested for product safety.
Note: Failure to provide any of this information before the start of your job, will result in the
project being re-scheduled. Providing partial information could cause your testing to be delayed
with only a construction evaluation performed. To insure that your project is not delayed,
please provide the necessary information as indicated by this document.
Please provide the following information as it applies to your product. Type this form in Acrobat
Reader or print and fill out, then fax (978-486-8828) or send the information to Donna Kearney,
Product Safety Coordinator.
1. Companies NRTL file number (UL, CSA etc.): ________________________________
2. If your project is a modification to an existing report, please indicate which reports you
are revising: __________________________________________________________
3. Product Name (as you want indicated on the report):___________________________
_____________________________________________________________________
4. Model Number (that will appear on the unit and in the report):____________________
_____________________________________________________________________
5. Serial Number of unit to be tested:_________________________________________
6. Manufacturing Address:_________________________________________________
_____________________________________________________________________
7. Brief description of the product’s function, environment of intended use and typical
configuration.
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
8. Please provide a copy of the current user’s manual and installation instructions if applicable.
9. For CB Scheme reports please include a copy of the marking plate for the product, this
includes the Company Name and the appropriate Model Number. If this information is silk
screened in the product you may provide drawings for the product.
10. Weight of the product:_________________________________________________
 1998 Curtis-Straus LLC • 527 Great Road • Littleton, MA • tel (978) 486-8880 • fax (978) 486-8828
Revision 1/27/00
Page 2 of 3
Product Safety SELV - P.I.Q.
11. Dimensions of the product:______________________________________________
12. The flame rating of all printed circuit boards contained in your product:______________
______________________________________________________________________
13. Please provide information for all connectors on the board. For these items please provide
the approvals, manufacturer, part number, and electrical ratings. Please attach this
information to the back of this document and write the number of the question on each
page.
14. The approvals, manufacturer, part number, electrical ratings for all lithium or re-chargeable
batteries contained in your product:____________________________________________
________________________________________________________________________
15. Schematic of battery circuit, identifying any reverse charging or overcharging protection.
________________________________________________________________________
16. For products containing lasers, please provide proof of approval to 21 CFR 1040 for the
laser modules or the entire product as applicable. For European Approvals, provide proof of
approval to IEC 825. Reports to these standards will be required to be provided for
completion of your reports.
17. For user accessible mouse port, keyboard ports and USB ports, please provide information
on components which limit the amount of current to the user.
 1998 Curtis-Straus LLC • 527 Great Road • Littleton, MA • tel (978) 486-8880 • fax (978) 486-8828
Revision 1/27/00
Page 3 of 3